Healthy Living: explaining
health behaviours
METHODS
OF HEALTH PROMOTION
·
MEDIA
CAMPAIGNS: Keating et al.
·
LEGISLATION:
Wakefield et al.
·
FEAR
AROUSAL: Janis and Feshbeck
METHOD:
MEDIA CAMPAIGNS
The
phrase “media campaigns” refers to various forms of media, which are used to
communicate and interact with a range of audiences. There are many forms of
media, but typically health campaigns tend to use print media, such as
pamphlets, electronic media, such as television and radio, and new-age media,
such as social networking. Media campaigns are a prominent method of health
promotion as there is a wide range of diversity and accessibility; most
households in the West own a television set, and almost everywhere has access
to newspapers or the Internet. Health media campaigns can be on various health
behaviours, including sexual health and drug use. Health media campaigns are
broadly based on the Yale Model of Persuasion from 1953, which describes how
for a campaign to be successful, it must consider the communicator of the
message, the communication of the message, and the target audience. The health
belief model, which roughly fits this but is more complex, is also often used
heavily in media campaigns, such as in the TV adverts for Change4Life and
Hands-Only CPR.
EVALUATION:
MEDIA CAMPAIGNS
Mass
media campaigns are a practical method of health promotion in that they can
reach a large population in a relatively short amount of time. However, they
require access to some resources that people don’t have, can be avoided or
ignored, and may not be seen by the full target population, which reduces the
effectiveness. Media campaigns are time effective, but not really cost
effective, and only reach a certain demographic – so many forms will be needed.
It is also important to remember that improved knowledge doesn’t necessarily
mean improved behaviour, and particularly stressful campaigns may cause people
to switch off from the message.
STUDY:
KEATING et al.
Keating
et al. conducted a study which aimed to assess the successfulness of the
mass-media campaign VISION on reproductive health and HIV/AIDS prevention. A
sample of 3278 participants aged between 15 and 49, from various ethnic and
economic groups in Nigeria was used. Verbal informed consent was given, and
then participants were asked various questions from a questionnaire on sexual
health, with 3 critical fixed choice (yes/no) questions: one on talking with a
partner about preventing AIDS, one on whether using a condom reduced the
chances of getting AIDS, and finally one on whether they used a condom on their
last sexual encounter. Chi square and regression analysis was used on the
results. It was found that media campaigns were more accessible by males, with
females being more exposed to the information from clinics. Exposure to VISION
was high, and this appeared to be associated with positive responses to the
first two questions; however appeared to have no effect on the third question.
It was therefore concluded that different media campaigns reached different
people, but whilst campaigns were successful in giving information, this did
not seem to directly lead to behavioural changes, and thus media campaigns
should also look at giving practical information on how to do certain health
behaviours (such as obtaining a condom).
EVALUATION:
KEATING et al.
The
study used stratified sampling to improve the representativeness of the sample,
which was important in Nigeria for ethnic balance. The sample was also large,
but ethnocentric to Nigeria. The study was ethical in that verbal informed
consent was given, however the questions were quite personal and this may have
caused embarrassment or psychological harm. The questionnaire appears to have
highlighted the important points about the success of media campaigns rather
efficiently; however it would have been more useful if reasons why condoms had
not been used had been included in the self-report – a pilot study could have
shown this. The study is useful in that it shows that information is not all
that is required for a behavioural change, which is something that could be
generalized or investigated further for other health behaviours. The study is
also useful as it shows the effectiveness of media campaigns varies by
population.
METHOD:
LEGISLATION
Legislation
refers to law making processes, and this is a method of health promotion as
laws can be implemented to change health behaviours, by promoting and enforcing
positive health behaviours, whilst banning unhealthy behaviours. Certain
behaviours that have been made illegal are smoking in public places and smoking
if under 18 (rather than 16), whilst behaviours that have been made compulsory
in a legal manner include wearing a seatbelt.
EVALUATION:
LEGISLATION
Legislation
raises the issue of freewill versus determinism, and the ethical nature of
forcing or banning certain behaviours. To what extent is it ethical or right to
ban dangerous health behaviours, or to enforce improved health behaviours? Some
would argue that the legislation against smoking in public places is denying
people human rights, such as freedom of movement, whilst others would suggest
smoking itself is so dangerous that it should be completely banned. In addition
to this, whilst legislation is far reaching and supposed to be enforced equally
wherever it applies, obedience is somewhat optional. In areas such as Greece,
where there is the same smoking ban as in the UK, people still tend to smoke in
public places due to the fact the authorities don’t fully enforce it.
Legislation is only effective if people listen to it and abide by the laws.
STUDY:
WAKEFIELD et al.
Wakefield
et al conducted a cross-sectional study into the effect of restrictions on
smoking at home, school and in public places on teenage smoking. A random
sample of 17,287 high school students was taken from over 200 schools in the
USA – one school in each county of mainland USA. A self-report method of a
questionnaire was used to gather demographic data and information on whether
adults and siblings at home were smokers, as well as their smoking history and
intentions. Participants were then classified into six categories, ranging from
non-susceptible non-smokers to established smokers. Further questions asked
about restrictions at home and school. Researchers also gathered information on
smoking bans and the strength of enforcement. The study found that legal
restrictions and enforced bans were significantly associated with not
developing an early smoking habit, that home bans were more effective that
legal restrictions on taking up smoking, and extensive restrictions on smoking
in public places were associated with lower probability of transition between
later stages of transition. However, school bans appeared to actually increase
the probability of transitions to the last stage. It was concluded that school
bans needed to be enforced to actually be effective and that although causality
cannot be deduced, their findings are consistent in showing that parental
opposition and banning smoking in the home reduces the uptake of smoking
amongst teenagers.
EVALUATION:
WAKEFIELD et al.
The
study used a very large sample, which although was not stratified was random,
and so likely to be representative of teenagers across the USA. As the findings
are consistent with earlier research, it is likely that the study is reliable;
however the use of self-report may reduce this as there is no sure way of
checking honesty or accuracy of memory. Social desirability bias may have
affected the results. As it was a cross-sectional self-report study, causality
cannot be deduced which reduces the usefulness and conclusiveness of the findings;
however it is not ethical to do an experiment to determine causality when
health is involved. The study highlights that there are complexities within
health behaviours, and that there are many factors to consider during health
promotion.
METHOD:
FEAR AROUSAL
Fear
arousal as a method of health promotion refers to using fear and intimidation
(usually through strongly emotive media campaigns) to persuade people into
doing (or avoiding) certain health-related behaviours. Fear-arousing
communication usually features two parts: stressing the severity of the issue
using fear, and recommending an action to reduce or eliminate the health risk.
The basic underlying assumption is that if the negative consequences of an
action are made clear to an individual, they will be more likely to do
something to prevent it. A large body of research into fear arousal suggests
that high fear campaigns tend to be more successful than low fear campaigns,
and this research was guided by the drive reduction model: the idea that fear
or emotional tension is a drive to action, and so if a threatening situation is
presented, individuals will feel motivated to take action to reduce the threat.
EVALUATION:
FEAR AROUSAL
The
major issue with fear arousal is the ethical considerations it raises. Causing
someone to feel fear goes against protection from harm, and actually causes
psychological harm, which is against BPS ethical guidelines. Aside from this,
although it is arguable that fear is a basic human emotion and as such fear
arousal is applicable to everyone, people feel and respond to fear differently
so fear arousal is unlikely to be effective for large populations. For example,
whilst a graphic advert showing the damage smoking does to your body may cause
some people to not take up smoking, smokers may ignore or avoid the messages
due to it being too emotional and distressing to watch. Fear arousal appears to
go against the Yale model, which outlines how too much emotion will not deliver
a message successfully, so this is a worthwhile evaluative point. It is
reductionist in the way that it is assumed fear arousal will automatically
result in a change in behaviour – what about social factors such as the
desirability or social pressure to conform to certain lifestyles, or
self-efficacy issues such as thinking they cannot do it, and nobody they know
would be able to.
STUDY:
JANIS AND FESHBECK
Janis
and Feshbeck conducted a cross-sectional study to investigate the consequences
on emotions and behaviour of fear appeals in communication. A 9th
grade freshman class at a US high school was used as the sample; they had a
mean age of 15 years. Janis and Feshbeck used a laboratory experiment, which
investigated how the strength of fear arousing material presented in a lecture
affected the emotional and behavioural changes in dental practices. An
independent measures design was used, with four conditions: strong fear appeal,
moderate fear appeal, minimal fear arousal, and the control group. A
questionnaire was used before the lecture and afterwards. The strong fear
arousal was generally received positively in terms of interest and necessity,
but also had higher levels of dislike and unpleasantness. It showed a net
increase in positive dental hygiene of 8%, whilst the moderate group had 22%
increase, and the minimal fear group showed 36% change. The researchers
concluded that fear appeals can be helpful in changing health behaviours,
however it is necessary for the level of fear arousal to be appropriate for the
appropriate target audience, and that (in teenagers) minimal fear is likely to
be more successful.
EVALUATION:
JANIS AND FESHBECK
The
sample was very limited in that it was small, ethnocentric and age-biased;
therefore it is unlikely that the findings could accurately be generalized much
further than other American high school students. However, it is useful in that
it highlights how high fear arousal does not always result in higher
behavioural changes. The use of questionnaires allowed experiences to be
relayed; however this raises the issue of internal validity due to the
possibility of demand characteristics, dishonesty and social desirability bias. The use of and findings from the control
group however did improve the likelihood that it was the independent variable
of fear arousal causing the behavioural changes. The other main issue with this
study is the ethics, as children were exposed to material that they knew would
be distressing and was intended to cause psychological harm, and whilst it was
to try to improve dental hygiene behaviours, the ends here do not justify the
means.
